Overview of allergic asthma
“Allergic Asthma” is a condition characterized by a tightening of airways due to allergen-induced allergic reactions, triggering asthmatic symptoms.
Allergens, substances capable of causing allergic reactions, can be encountered through inhalation, touch, ingestion or injection, triggering asthma symptoms.
A significant portion of individuals with asthma are at a higher risk of experiencing allergic reactions. Recognising the allergens and understanding the potential threats posed by asthma symptoms is crucial. Being well-informed of asthma symptoms and prompt treatment is paramount in preventing severe respiratory conditions or severe asthma attacks.
Allergic asthma vs. other types of asthma
Although allergic asthma shares symptoms with other types, it is specifically caused by indoor or outdoor allergens. In contrast, non-allergic asthma could be caused by other triggers such as smoke, pollutants, exercise, viruses, and weather.
Allergic asthma could lead to early symptoms, whereas non-allergic asthma has a later onset after exposure to triggers.
Studies on asthma patients, including both allergic and non-allergic asthmatic patients, reveal that advanced age, female gender and sinusoidal polyposis increase the risk of developing non-allergic asthma. Nevertheless, no distinctions in the asthma symptoms were observed between allergic and non-allergic asthma cohorts.1
Triggers of allergic asthma
Allergic asthma is primarily caused by allergens. Such examples are :
- Airborne allergens such as mould, dust mites, pollens and animal dander
- Cockroaches
- Rodents
- Drugs or medications such as antibiotics (penicillin), NSAIDS (ibuprofen)
- Certain types of foods such as eggs, nuts (peanut and tree nut), fish, soy, wheat, dairy and fish.
- Genetics2
Symptoms of allergic asthma vs symptoms of allergies
There are a few symptoms of Allergic Asthma:
- Shortness of breathing / Sense of Breathlessness
- Chest tightness
- Wheezing
- Coughing
- Reduce peak flow meter readings in a hospital setting
- Worsening symptoms at night
It is essential to recognise the symptoms of allergies in a patient with a history of asthma for immediate treatment of allergic reactions before worsening asthma symptoms. Symptoms of allergic reactions could be:
- Body itchiness
- Swollen lips or eyes
- Urticaria or hives
- Sneezing
- Runny nose
- Severe allergic reactions or anaphylaxis with the presentation of stridor, shortness of breath, appearance pale/blue/confusion and feeling of impending doom
Diagnosing allergic asthma
Most of the time, patients often present in the emergency room with acute asthma attacks, necessitating immediate life-saving treatment. Rapid and accurate diagnosis by medical practitioners is crucial.
Allergic asthma can be diagnosed with a few steps:
- History taking - Medical practitioners inquire about the patient’s asthma history, episode patterns (night or daytime), and exposure to specific allergens. Additionally, gathering information on asthma symptoms helps differentiate it from other respiratory conditions.
- Physical findings - Differentiation of allergic asthma from other respiratory conditions is possible when expiratory noises are transmitted from the upper airway, such as the larynx and pharynx, mimicking wheezing. Patients may describe the symptoms as wheezing, sometimes audible, without a stethoscope.
- Systemic symptoms - Physical findings are not limited to respiratory conditions in acute asthma attacks. Asthmatic patients may exhibit severe airflow obstruction, presenting with tachypnea, tachycardia, use of accessory muscles, and pale and cyanotic appearance during breathing. These indicate severe asthma attacks requiring immediate interventions.
- Pulmonary function test - A few types of Pulmonary Function Tests are conducted using devices or mouthpieces, requiring patients to inhale and exhale pre and post-medications called bronchodilators. Such devices could be Spirometry, Peak Flow Meter, the FeNO test, and the Provocative test.
- Chest X-rays - Chest X-rays are not generally used to diagnose asthma. However, it is essential to rule out other respiratory conditions, such as Bronchitis, Pneumonia, and Lung tumours, causing obstruction or fluid accumulation in the lung or pleural effusion. While less critical in the acute setting compared to the line diagnosing method before receiving medical treatment for an asthma attack.
6. Allergic test - Medical professionals conduct controlled allergic tests to identify allergens that could trigger individual allergic asthma or reactions. It could be done with a skin prick test, blood test, and diet diary to identify the suspected medications or foods causing allergies.
Managing allergic asthma
Effectively managing allergic asthma is crucial in controlling the condition, as asthma attacks can escalate to severe levels. Here are some key strategies for managing allergic asthma:
- Identify and avoid allergens - Medical practitioners identify the potential allergens that could trigger allergic reactions, often originating from the surroundings. Once learned, it is essential to manage interaction, and it is helpful to avoid interaction with allergens.
- Initial detection of symptoms - Individuals should actively detect and track asthma symptoms as it helps to spot patterns. Recognising early signs, such as wheezing, shortness of breath and chest tightness, allows for better preparation against asthma attacks.
- Allergic asthma action plan - The American Lung Association has developed An Asthma Action Plan. This worksheet outlines individual steps to be taken as asthma progresses, aiding. Individuals, parents, and children’s caregivers are involved in managing the condition, especially in school and daycare settings.
- Stick to the medications provided - Individuals with allergic asthma typically rely on inhalers. It is essential when symptoms appear. However, if asthma symptoms persist or worsen despite inhaler use, it could be life-saving to visit a hospital.
Medications used for asthma relievers could be quick-relief medications or long-term control medicines.
Allergic shot (Immunotherapy) in allergic asthma
The allergic shot, also known as Allergen Immunotherapy, is a form of long-term treatment to reduce the symptoms of allergic asthma, allergic rhinitis, allergy conjunctivitis, and allergy from insect bites such as bees or wasp stings.
Immunotherapy is recommended for individuals dealing with multiple allergies. For example, patients with allergic asthma are often comorbid with allergic rhinitis, food allergies, and atopic dermatitis. It is important to note that allergic shots are not recommended for children younger than five years old. [3]
An allergic shot can be administered via subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT). Both approaches are efficacious in treating allergic asthma, with the choice of allergens depending on the patient’s specific sensitivities. These allergens may include house dust mites, pollen, pets, moods or other environmental allergens.
According to the American Academy of Allergy Asthma and Immunology, allergic shots have the build-up phase and maintenance phase.
The Build-up phase involves one or two injections with a build-up dose of allergens per week. This phase could last for 3 to 12 months to observe the symptoms. Once the effective amount of allergens is achieved, The maintenance phase begins. The period between shots in the maintenance phase is longer, up to two to four weeks. The maintenance phase could last between 3 to 5 years.
The benefits of allergic shots are effective in treating allergic asthma, including the reduction of asthma symptoms, reliance on medications, and corticosteroid use for asthma control. Allergic shots have demonstrated effectiveness in decreasing the susceptibility towards severe asthma attacks and exacerbations.
However, the allergic shot may elicit reactions. Individuals may experience local redness and swelling at the injection site. At the same time, instances of anaphylaxis are extremely rare. Nevertheless, it is crucial to receive an allergic shot in the presence of an expert or medical professional.
Failure of an allergic shot may be due to several factors, such as the use of allergens that are not specific or sensitive to the individual or insufficient allergen doses in the allergy vaccine. Exposure to other allergic triggers or elevated levels of surrounding allergens, such as smoke, could also lead to unsuccessful allergic immunotherapy.
Allergic asthma awareness
Asthma awareness is crucial for early detection and diagnosis. Individuals with asthma and their carriers sometimes mistake asthma for seasonal allergies, leading to difficulty in detecting or recognising asthma symptoms and depriving access to immediate asthma treatment. Eventually, this led to unmanaged asthma, the possibility of severe asthma attacks, and reduced quality of life.
A critical aspect of promoting asthma awareness is to enhance allergen avoidance strategies. Having knowledge about common allergies, maintaining a diary, and creating an asthma action plan to identify the asthma triggers could help individuals and their carriers to take control of their environment and minimise asthma triggers in daily life. Measures such as taking a walk as much as possible during high pollen season, keeping the potential triggering drugs off the counter and calling for pest control would make a difference in asthmatic patients.
As the global awareness of allergic asthma increases, more research, innovation, and research-based treatment can be driven. It is an excellent initiative for investment in developing new treatments and therapies by pharmaceutical companies.
Allergic asthma awareness is a powerful tool for promoting and improving the lives of individuals with asthma patients, as it leads to an improvement in the quality of life and better support for both affected individuals and carriers. Through awareness by spreading knowledge and fostering empathy, allergic asthma is better understood and effectively managed, leading to a better quality of life for all.
Summary
Allergic asthma is a type of asthma triggered by allergens through inhalation, ingestion, touch or injection. It shares some symptoms with non-allergic asthma, like wheezing and coughing, but has an earlier onset after allergen exposure.
Allergic asthma can be diagnosed through medical history, physical exams, pulmonary function tests, chest x-rays and allergy tests. To manage allergic asthma, patients should avoid triggers, detect symptoms early, follow an action plan, take medications as prescribed, and consider immunotherapy.
Raising awareness promotes early detection, better avoidance strategies and more research into new treatments.
References
- Romanet-Manent S, Charpin D, Magnan A, Lanteaume A, Vervloet D, and the EGEA Cooperative Group. Allergic vs nonallergic asthma: what makes the difference? Allergy [Internet]. 2002 Jul [cited 2023 Sep 11];57(7):607–13. Available from: http://doi.wiley.com/10.1034/j.1398-9995.2002.23504.x
- Borish L. Genetics of allergy and asthma. Annals of Allergy, Asthma & Immunology [Internet]. 1999 May [cited 2023 Sep 15];82(5):413–26. Available from:https://www.annallergy.org/article/S1081-1206(10)62715-9/pdf
- Ankermann T, Brehler R. Allergic asthma: An indication for allergen immunotherapy. ALS [Internet]. 2023 Jan 1 [cited 2023 Sep 15];7(1):33–8. Available from: https://www.dustri.com/article_response_page.html?artId=190120&doi=10.5414/ALX02332E&L=0
